Sleep apnea is a common but serious sleep disorder where breathing repeatedly stops and starts during sleep. These interruptions, known as apneas, can last from a few seconds to minutes and may occur 30 or more times an hour. When breathing pauses, the body and brain can be deprived of oxygen, leading to various health issues. 

People diagnosed with sleep apnea often experience several symptoms. They could experience loud snoring, gasping for air during sleep, headaches, excessive daytime sleepiness, and difficulty concentrating. Sleep apnea can cause serious health complications such as high blood pressure, heart disease, stroke, diabetes, and depression if not treated.

On the other hand, obesity is one of the risk factors for the development of obstructive sleep apnea. An excess body weight, particularly around the neck and upper airway, can lead to the narrowing or obstruction of the airway during sleep.

Interestingly, there are few studies suggesting that some people with obstructive sleep apnea (OSA)s are non-obese. This challenge the traditional understanding of this condition. The Apnimed Inc., is well-known clinical-stage pharmaceutical company, recently presented five key studies and hosted a symposium at the SLEEP 2024 annual meeting. One of the highlights was an epidemiologic study that revealed most OSA patients are not obese.

Sleep Apnea Among Non-Obese Individuals

Commonly, past studies have linked OSA to obesity, reporting prevalence according to varying obesity categories. Yet, a recent study “0866 Prevalence of Obesity in Obstructive Sleep Apnea Within a Large Community-based Cohort of Middle-aged/Older Adults,” was published on April 20, 2024. This study aimed to identify the prevalence of obesity in different levels of OSA severity, age, and sex. It sought to provide a more better understanding by interpreting a large community-based cohort.

Methods, Participant Details and Results

The analytic sample included individuals with OSA from the SHHS. OSA severity was quantified using the apnea-hypopnea index (AHI4), which measures apneas and hypopneas with at least 4% oxygen desaturation per hour. Participants were stratified by the severity of OSA (mild: 5≤AHI4< 15; moderate: 15≤AHI4< 30; severe: AHI4≥30 events/hour), body mass index (BMI), age, and sex.

Out of 5,749 participants in the SHHS, 2,950 had OSA (AHI4≥5 events/hour), with 1,729 classified as mild, 788 as moderate, and 433 as severe. The study sample was diverse, with 40.6% of participants being female. The mean age was 65.3 years, with a standard deviation of 10.7 years, and the median BMI was 28.8 kg/m2. Interestingly, 60.6% of participants with OSA were non-obese (BMI<30 kg/m2), while 39.4% were obese (BMI≥30 kg/m2).

Conclusion and Future Directions

To conclude, the majority of middle-aged and older adults with OSA are non-obese, challenging the common perception that OSA predominantly affects obese individuals. What’s more the association between obesity and OSA varies by age and sex, with a higher prevalence of obesity in younger adults and females with OSA. These findings suggest that healthcare providers should consider a more comprehensive range of factors when diagnosing and treating OSA, rather than relying solely on BMI.

On top of that, further research is being conducted to explore the association between OSA and obesity within other community-based samples. One such is the Multi-Ethnic Study of Atherosclerosis, the Osteoporotic Fractures in Men study, and the HypnoLaus study. These additional analyses will help establish a more detailed understanding of the relationship between OSA and obesity across different populations.

Disclaimer: The findings presented in the study “Prevalence of Obesity in Obstructive Sleep Apnea Within a Large Community-based Cohort of Middle-aged/Older Adults” are based on data from the Sleep Heart Health Study (SHHS) and other referenced studies. The study may provide new insights into the prevalence of obesity among OSA patients. But, it is important to remember that the results may be different across different populations and individual cases.

The association between obesity and OSA is influenced by various factors, including age and sex. Which may not be fully captured in this analysis. We advise the readers should interpret the results with caution. As well as consult healthcare professionals for personal medical advice. The study’s conclusions are intended to inform and support further research. Not to replace professional medical diagnosis or treatment. Apnimed Inc. and the researchers involved in the study are not liable for any actions taken based on the information presented.

What Are the Symptoms and Health Risks for Non-Obese Sleep Apnea Patients?

Sleep apnea could occur in individuals of all body types. Could be those who are skinny or have a normal body mass index (BMI). 

Symptoms of sleep apnea in non-obese individuals may include:

  • Loud snoring
  • Episodes of gasping or choking during sleep
  • Daytime fatigue or sleepiness
  • Morning headaches
  • Difficulty concentrating
  • Irritability or mood changes
  • Decreased libido
  • Frequent nighttime urination

Health risks associated with untreated sleep apnea in non-obese individuals may include:

  • Increased risk of cardiovascular diseases such as hypertension, stroke, and heart disease
  • Greater susceptibility to metabolic disorders like diabetes
  • Impaired cognitive function and memory problems
  • Worsening of mood disorders such as depression and anxiety
  • Higher likelihood of accidents due to daytime sleepiness

It’s essential for individuals experiencing symptoms of sleep apnea, regardless of their weight, to seek evaluation and treatment from a healthcare professional. A proper diagnosis and management plan can help improve sleep quality and reduce the risk of associated health complications.

Treating Sleep Apnea for Non-Obese Patients With CPA 

Continuous Positive Airway Pressure (CPAP) therapy is the gold standard treatment for Obstructive Sleep Apnea (OSA). CPAP uses a machine to gently deliver constant air pressure through a mask you wear while sleeping. This pressurized air keeps your airway open, preventing the blockages that cause sleep apnea symptoms like snoring and gasping for air. 

Although adherence to this treatment may be lower in non-obese individuals, CPAP remains the first-line treatment option for non-obese OSA patients as well. Because CPAP is non-invasive and simply supplies air, it’s a safe and highly effective way for non-obese patients to get a good night’s rest and avoid the health risks associated with untreated sleep apnea.

How Can Non-Obese Patients Manage Sleep Apnea?

Managing sleep apnea in non-obese patients could be a challenges. It  may require different treatment or a combination approach. However, several alternative strategies and lifestyle modifications can help effectively manage sleep apnea and improve overall quality of life.

Lifestyle Modifications

Weight Management

Although non-obese, maintaining a healthy weight can still play a significant role in managing sleep apnea. Even modest weight loss can lead to improvements in symptoms by reducing the severity of airway obstruction during sleep.

Avoidance of Alcohol and Sedatives

Alcohol and sedatives can relax the muscles in the throat, worsening sleep apnea symptoms. Non-obese patients should limit or avoid alcohol consumption and discuss alternative medications with their healthcare provider.

Sleep Position

Sleeping on the back can exacerbate sleep apnea by causing the tongue and soft tissues to collapse into the airway. Encouraging non-obese patients to sleep on their side can help alleviate symptoms.

Alternative Therapies

Oral Appliances

Mandibular advancement devices (MADs) can help keep the airway open by moving the lower jaw forward during sleep. These devices are a popular alternative for patients who are unable to tolerate CPAP therapy.

Upper Airway Surgery

In some cases, surgical interventions may be considered to address anatomical abnormalities contributing to sleep apnea. Procedures such as uvulopalatopharyngoplasty (UPPP) or septoplasty aim to widen the airway and reduce obstruction.

Hypoglossal Nerve Stimulation

This therapy involves implanting a device that stimulates the hypoglossal nerve to keep the airway open during sleep. Hypoglossal nerve stimulation has shown promising results in non-obese patients with sleep apnea even it is new and was approved only in 2014.

Non-Anatomical Interventions

Behavioral Therapy

Cognitive-behavioral therapy for insomnia (CBT-I) can help improve sleep quality and reduce the frequency of apnea events. Trying different techniques,such as sleep hygiene education and relaxation training can be particularly beneficial for non-obese patients with sleep apnea.

Positive Airway Pressure Therapy Optimization

Optimizing therapy settings and providing ongoing support and education can improve compliance for non-obese patients who struggle with CPAP adherence. Additionally, newer CPAP devices with advanced features such as automatic pressure adjustment and mask comfort options may enhance tolerability.

Multimodal Approach

Combination Therapies

Nowadays, combining different treatment modalities, such as CPAP therapy with oral appliances or behavioral therapy, may yield synergistic effects and improve overall outcomes.

Regular Follow-Up

Regularly doing follow-up check-ups or appointments with a sleep specialist is needed to better monitor the treatment progress and may adjust interventions as needed. Specifically, non-obese patients should communicate any concerns or difficulties they encounter with their healthcare provider to ensure optimal management of their condition.

The information provided here is for educational purposes only and should not be considered as medical advice. Sleep apnea or any other medical condition should be treated. Consult with a qualified healthcare professional for diagnosis and treatment options.

We Can Help

We’re here to help. Our  Insomnia and Sleep Institute of Arizona team of specialists is dedicated to setting the standard for sleep medicine practice in Arizona. As a physician-owned and operated institute, we take pride in offering top-rated care to serve you best.

Our experts specialize in all aspects of sleep care, including the treatment of sleep apnea in both adult and pediatric patients as young as one year old. Whether you’re struggling with CPAP therapy adherence, trying alternative treatments, or seeking lifestyle modifications to manage your sleep apnea, our team is here to provide personalized care tailored to your needs.

Contact us today at (480) 745-3547 and schedule an appointment at one of our locations in Gilbert, Phoenix, or Scottsdale. You can also visit our website to learn more about our services and meet our team of sleep medicine leaders. Let us help you take the first step towards better sleep and improved quality of life.

References

 

Esmaeili, N., Gell, L., Taranto-Montemurro, L., Messineo, L., Imler, T., Sands, S., Yee, J., Cronin, J., Wellman, A., White, D. P., Heinzer, R., Redline, S., & Azarbarzin, A. (2024). 0866 Prevalence of Obesity in Obstructive Sleep Apnea Within a Large Community-based Cohort of Middle-aged/Older Adults. Sleep, 47(Supplement_1), A372–A372. https://doi.org/10.1093/sleep/zsae067.0866

Gray, E. L., McKenzie, D. K., & Eckert, D. J. (2017). Obstructive Sleep Apnea without Obesity Is Common and Difficult to Treat: Evidence for a Distinct Pathophysiological Phenotype. Journal of Clinical Sleep Medicine, 13(01), 81–88. https://doi.org/10.5664/jcsm.6394

Sleep Review Staff. (2024, May 23). Most Sleep Apnea Patients Aren’t Obese, Apnimed Study Finds. Sleep Review. https://sleepreviewmag.com/sleep-disorders/breathing-disorders/obstructive-sleep-apnea/most-sleep-apnea-patients-arent-obese-apnimed-study-finds/

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